DSM-5 Release Likely to Steal the Spotlight at APA Meeting

May 17, 2013

SAN FRANCISCO — Integrated care, the growing problem of addiction, bullying, cyberbullying, and telepsychiatry are among the “hot” clinical topics being presented at the American Psychiatric Association’s (APA’s) 2013 Annual Meeting, but none are likely to garner as much attention as the release of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

“There are going to be a ton of sessions on the DSM-5, of course, because it’s the culmination of over a decade’s worth of work,” Josepha Cheong, MD, the APA chair of the meeting’s Scientific Program Committee, told Medscape Medical News.

“It’s become a focus of the meeting because we’re attempting to provide for the general APA member a direct line to the developers of the manual in terms of what’s different between it and the DSM-IV and DSM-IV-TR. This is a major event in psychiatry,” added Dr. Cheong, who is also associate professor of psychiatry and neurology at the University of Florida in Gainesville and medical director of the Inpatient Geriatric Psychiatry Unit at Shands Hospital, also in Gainesville.

Far-reaching Implications

Dr. Cheong noted that the release of the DSM-5 is incredibly important because “it affects everything from how these diagnoses are used in treatment as well as in research as well as in finance.”

“So it has far-reaching implications. The sessions at the meeting provide an opportunity for the general [APA] member to talk directly to members of the DSM-5 committee and to find out ‘where do we go from here?’ ”

A special DSM-5 track will include more than 20 sessions and workshops that focus specifically on substance use disorders, autism, major depression, and bipolar disorder, as well as cultural implications, opportunities and challenges for residents, and more.

“Even after the DSM is released, there’s still work that goes along with it, in terms of the implementation and in terms of education,” said Dr. Cheong. “I don’t think that it’s ‘done,’ per se. Basically, the development may be completed, but the process, in terms of widespread dissemination to all practitioners and researchers, has just begun.”

Other important topics that will be presented in several sessions include the troubling increase in addictive behaviors in adolescents, especially with regard to the Internet and smartphones; bullying (especially of lesbian, gay, bisexual, or transgendered [LGBT] youth), and the growing importance of providing psychiatric services to returning veterans and their families.

In addition, the keynote speech will be given by former president Bill Clinton.

Information on this year’s meeting in the “City by the Bay,” including a downloadable program, is available on the APA’s Web site.

Also highlighted at this year’s conference will be collaborative and integrated care.

“One of the major things at this meeting is the integration of psychiatry and primary care clinics. For example, geriatric psychiatry in primary care. You have better care of an individual because you have co-located clinics and/or consultants basically within the same space and time, which is certainly different than constantly having to refer people out,” said Dr. Cheong.

In total, there will be 17 sessions on integrated care, including 2 by Wayne Katon, MD, professor and vice-chair in the Department of Psychiatry and Behavioral Sciences at the University of Washington School of Medicine in Seattle.

According to a release from the APA, approximately 40% of patients seen in primary care settings have need of psychiatric treatment.

“Conversely, persons with serious mental illnesses typically have physical health co-morbidities and would benefit from readily accessible primary care and preventive treatments,” they write. “The integrated care educational track…is particularly timely with the continued implementation of the health care reforms scheduled for 2014.”

Addiction

Another hot topic this year is the treatment and management of addiction — of all types.

“Addiction is always a big, big focus. Whether it’s addiction to a specific agent, such as bath salts, or the issue of obesity and eating addictions,” said Dr. Cheong.

A track to be presented jointly by the APA and the National Institute on Drug Abuse (NIDA) is entitled, “Advancing Psychiatric Practice Through the Science of Addiction.” This track will include 13 sessions, including several presented by Nora Volkow, MD, director of NIDA, and will discuss topics such as new smoking cessation treatments, substance abuse and mental health comorbidities, and updates on prescription opioid abuse and treatment options.

In addition, a separate session will examine the effects of smartphone and Internet addiction on adolescent psychopathology.

“The intrusion of your virtual life into your daily life can be a real problem. I think a lot of people spend a lot more time interacting with people virtually then they do person to person,” noted Dr. Cheong.

“I bet a significant portion of the population interacts more through digital media and technology, whether it’s through the Internet or Facebook or texting, than they do with phone calls and direct conversation,” she said, noting that this could interfere with an adolescent’s normal development of social skills.

In the same vein, Baroness Susan Greenfield, PhD, will discuss “Digital Technology and the Developing Mind” during an invited presentation on Tuesday.

“Basically, she’ll discuss: what is the impact, what are the social implications, and what are potential solutions? She’s a noted neurobehavioral scientist, and this is definitely a noteworthy topic,” said Dr. Cheong.

“Silent Epidemic” of Youth Suicide

Although using too much digital technology is not good, Dr. Cheong noted that it can be extremely helpful when it comes to providing much needed services.

“Telepsychiatry or the use of technology in the delivery of healthcare and education is vitally important. So we have multiple sessions focusing on that. I think there’s a nice balance between the advantages of increasing the use of technology in healthcare, in particular, delivery of mental health, but also in terms of how does the average clinician uses technology in running a practice or taking care of patients. I think that’s a big deal.”

Another important topic is the issue of bullying and suicide “and the mental health crisis of LGBT youth,” said Dr. Cheong.

“In the aftermath of the Tyler Clementi suicide at Rutgers and trial, it sheds light on this silent epidemic of suicide among these young people,” she said.

In addition, results from the 2011 Youth Risk Behavior Survey on bullying, cyberbullying, and teen suicidality will be released.

To keep better track of any of these or other sessions, attendees can create a custom conference schedule using the APA 2013 Annual Meeting Itinerary Planner. Or the Annual Meeting App can be downloaded to access information on room changes, convention center maps, or tips on local restaurants. The official twitter hashtag for the meeting is #APAAM13.

Work Hard, Play Hard

“San Francisco is one of my favorite places,” said Dr. Cheong, adding that she has been paying frequent visits to the city for more than 23 years.

Her top recommendations for things to do (for attendees who find some free time in their schedule) include checking out the San Francisco Museum of Modern Art, which is within walking distance of the convention center, and taking a 15-minute walk or 5-minute streetcar ride down to the Ferry Building Marketplace — especially during the weekend’s farmer’s market or for lunch during the week.

“They have a ton of different places, and you will never have better food. And the Marketplace has the best gelato,” said Dr. Cheong.

“If you have some time in between sessions and you just want to get out into the open, check out the Yrbo Buena Gardens, which is attached to the Moscone Convention Center. It’s just this cool green space,” she added.

Some of her top restaurant recommendations include Scoma’s on Pier 47: “always casual, always crowded, always [worth] a stop”; the Slanted Door for “outstanding Vietnamese cuisine with great atmosphere and energy”; and Ebisu: “one of the best sushi places in a city that loves sushi.”

Dr. Cheong said that she hopes clinicians have a lot of fun but will also take away several key points from the meeting that they can implement immediately.

“Whether it’s in education or in direct clinical care, whether it’s a new type of therapeutic model or being aware of the kind of medications available or a better way of diagnosing a certain kind of disorder, if they took away 3 things they could put into their daily practice, I think that would be the goal of anyone who puts together any type of educational program,” she said.

“I’m also hoping they come away with a sense of optimism about where the field is going. It’s a vibrant field, it’s a developing field, and we really are reaching towards doing something better for our patients every day.”